I don't get numb anymore

[Mailady]

Hi. I'm new here and have read several posts. Thank you so much for being here. I have had a lot of dental work done over the years, and am 52. The last two times I went to my dentist, my teeth would not numb. Over a year ago, I felt the drill in a small cavity on my right lower side, third tooth from back. He just barely got it done when I flinched.Thank God he was done. I waited for over a year to go back. I went last Friday, and figured this time I will get numb (for two small cavities in front upper teeth). The dentist came in, and put the nitrus mask on me and said, we're gonna clear this real quick. I figured that meant run some air through it or something. He then came in in a couple of minutes and did the numbing jell, then the injections. I feel he did the injections a little fast.I could also feel the anesthetic run into my mouth. He came back in a couple of minutes and popped a rubber dam on my tooth.When he did that, I felt the clamp or whatever "snap" on my gum like there was no numbing, and just by it hitting the tooth, I felt the tooth sensitivity. I told him I could still feel the tooth, so he did another quick injection. Then he started to drill and I felt like someone had blown ice cold air on a sore tooth! I raised my hand, the assistant kind of pushed it back down, and he started to drill again. The same sharp pain. I sort of made a "cry whine" noise and he quit, and put a temporary filling in.He was frustrated and took off his mask.He said from now on I will have to go to a dentist that does IV sedation. (The whole time this was going on I was breathing real deep trying to suck in all the nitrus I could, but it felt more like energizing oxygen.It's been about 18 years since I had nitrous, and when I had it before, the lights started looking weird, the sounds in the room went weird, and at times I felt myself wanting to grin.None of this happened this time.I wonder if they forgot to turn on the nitrous?) Anyway, today I drove over two hours to get to the clinic that would do my teeth with IV sedation. To do all the work he thought needs to be done would cost almost $11,000.00. Anesthesia is over $600 per hour for 6 hours.I can't afford that. I am so disheartened. I have 3 choices. Let my teeth rot. Endure sharp, horrible nerve pain while I get drilled on. Pay all that money for IV. I cannot afford the third choice. There is another Dentist here that does sedation dentistry.(We're a small town far from the big ones). A little over a year ago my dentist sent me out of town for an evaluation that turned into an extraction. I was given a sedative, the tooth was pulled, and I hardly remember that day. I feel there HAS to be a way to find out why I won't get numb, and correct it. I AM anxious when I go in, and every bad experience exaserbates it. If it is anxiety, wouldn't meds help? (I took one valium last friday one hour before I went in, but had eaten an hour before I took it). I don' take any meds, have one cup of coffee in the morning, and wait forever to even take anything for a headache or pain. Since I never take anything, why would my body be used to the noicaine stuff? I also have had anxiety because I broke my wrist both bones 8 weeks ago. It has been frustrating, maybe that affected my adrenaline?? Cast came off today..hooray!! Now, the big tooth problem. Should I try the dentist who does Sedation with pills? I spoke briefly with their front desk person and she said there are different anesthetics for numbing too. My dentist discouraged me from going to the other dentist and wanted me to go to the one that I found out today costs so much. I feel my dentist has gotten less patient in the last couple of years. I left there friday feeling like a big pain in the butt. It's not my fault though!! Thanks for listening.
PS The dentist at the expensive place said it looks kinda like I have a virus in my gums in front??Reddish spots?/related to Chicken pox?? Could that affect numbing?

 

[Gordon]

Sounds to me a bit like your first dentist screwed things up royally, a combination of 3 possibles...
1) Not enough nitrous in the gas/air mix
2) Either no local in your mouth at all or not enough
3) Rushing before the local had worked properly.

I would go find another GP, explain your story and take it from there.

 

[brit]

Hi Milaidy and
That all sounds a bit like US - style production line dentistry gone mad to me. How much work do you really need for dental health to be restored? US$11,000 is a lot of anyone's money...it makes the extra $600 for 6 hours of i/v sedation sound reasonable....they can do an awful lot of stuff in 6 hours.

Personally I'd give the small town dentist a try where you had the good experience before....and just ask to be rendered 'dentally fit' not 'smile makeovered' ...it could make quite a difference to the total bill maybe.

Very strange behaviour from the first dentist....maybe you're not the only one of his patients who has problems getting numb...the trouble is too many people put up with it ....and don't realise it's not supposed to be like that.

Good luck....it wasn't your fault at all...it probably won't happen elsewhere.

 

[shub2974]

Brit.........i think she said $600 and hour so thats even worse! i agree iwth asking for a healthy mouth , not a perfect mouth. I went on Monday for the first time in 17 years and teh first thing i said is"iwant a presentable mouth" not a perfect one. Now mind you most of my front teeth are in good shape, so i was able to say that, the back ones are horrid. I have to go next Friday and get 8 ectractions, 2 are surgical , 1 regular, and 5 root tips taken out. I am horrified. Mainly about teh actual procedure itself.

So altogether i am getting
8 extractions
1 regular cleaning
4 different appointments for scaling and planing
6 fillings
and the total is going to be $2700 which i was pleasantly suprised that i can get all fixed for that he did have to crowns on there that i said no to for now. The 2 teeth he recommended them for were 2 that have had silver fillings in them for 20 yaers but they do not bother me and the teeth are fine so i said i will wait and save myself $2000 $! ARe you going to have to have bridges, crowns ect? Id that the reason for the cost. I too am in the US.

 

[Mailady]

Thanks for your replies.It is so comforting in this to be able to talk and ask questions. The dentist who is my regular dentist has been my dentist for about 18 years. I went to him because they "catered to cowards". He has always been really good at giving shots, and was always patient, but in the last couple of years, he seems less "friendly" or patient. I have a friend at work who also goes to him, and she mentioned a few weeks ago she thought he was different lately.I feel like he thinks of me as a pain in the butt now. I feel like he thinks I'm a weirdo anxious person. I really like his office ladies, and feel guilty, but I believe I am going to switch to the other dentist who does the pills. The other dentist had an article in the paper last night about the practice, and that said they had the solution for the fearful dental patient. It says they have had complete special training that allows them to treat fearful people while they are safely treated, and that they have always been sensitive to their patients with high fear and apprehension. I have never been to the new clinic, but was given pills by a specialist in another city last year who my regular dentist referred me to. That was the day I barely remember when they took out a bad back tooth. I almost have the guts to call the new office. I am still scared I might feel intense pain when they drill..almost like that would hurt worse than the tooth they pulled. I hate that drill!! There has been several times over the years that I had to get several shots, but once I knew I was numb, I did okay. I don't like shots either, but can very well put up with that short prick of the needle if I know it will get me numb for the drilling. Gordon, as a dentist, would you say it is definately anxiety causing me not to get numb? I really like knowing the mechanics of things, how they work, etc.
Brit, thanks for replying and caring. That sedation was going to be $600 per hour, so it added up to over $3800 for 6 hours. I figure if a pill will do me good for little cavities, right in my home town, I should try that. If I was rich, it would be wonderful to have the IV sedation and get everything done at once. Cavities, crowns, bridge, and a wisdom tooth behind my back molar that the out of town dentist says has decay in the wisdom tooth which lays sideways.
Gordon, the dentist I am planning on visiting has a site called smileastoria.com.Would you consider taking a look and telling me what you think? Thanks so much.

 

[brit]

Sorry - attention to detail slip there....US$ 600 per hour for i/v sedation sounds pretty steep.

Maybe your original dentist is going through a mid-life crisis and its not just you who has noticed the difference....his being less than warm and welcoming in my experience, is going to make you feel less comfortable and more nervous but maybe he just cocked up rather than it being your nerves which stopped it from working last time.

With a different dentist, you may even change your mind about needing sedation. ...but as you say the oral sedation route is better value in any case.

Don't know if Gordon has time to browse websites but it looked fine to me.
Good luck

 

[Gordon]

Anxiety makes you less likely to get numb. Numerous factors influence this, including higher blood pressure, increased perception, faster pulse and a few more things that happen when you're anxious. It tends to be a negative spiral too, when you don't get numb, it makes you more anxious which makes you less likely to get numb and so on

That's a really OTT flashy website, as a somewhat dour Scotsman it makes me cringe a bit reading it. Put it down as a cultural difference, rather than anything negative.

 

[brit]

Hi Gordon
1. Just wondering how significant is this anxiety effect.....are you only talking about fairly high levels of anxiety...where you feel 'physically scared'. If you are physically relaxed and not tense (I'm good at physically relaxing once in situ) does that preclude anxiety preventing numbing from working?
2. If you left and then got numb - that would be a sign that anxiety was the problem - true or false?
3. So what's the answer to this for patients who can't easily physically relax....is it really just nitrous (not that widely available in Europe) or is it improved chairside manner, hypnosis etc? Should people reschedule?
4. Why does anxiety not seem to interfere with other forms of medical numbing? Is this a uniquely dental problem? Actually maybe I don't want to know the answer to that .

Although I don't believe I've ever had this problem from anxiety, reading about it so much on here almost makes me think we'd all be better off only patronising practices with extra facilities such as nitrous just in case. Demand would certainly exceed supply in that event.
Hard job you dentists have got! Makes me grateful for the majority of decent ones I have encountered.

 

[Mailady]

Thanks so much Brit and Gordon for your replies and good info. I just need to get my scared butt in to the new dentist and do this. I am not good feeling rejected, and hate confrontation, so I don't even want to discuss it with my old dentist. I need someone who will go the extra mile with me and help me get relaxed and numb. I still have a fear of sitting there all drugged up and still feeling the sharp pain and not being able to move or say anything. I really want to get past this though. I guess above all I would like to know everything that it takes to successfully get numb. Your answers have really helped. That really IS what happened to me. The more I didn't get numb, the more anxious I was, and it spiraled downhill. I also felt worse, like I was a pain in the butt to the dentist, and I find myself never wanting to "bother" others, like it is my duty to not make my dentist frustrated...so that adds to the anxiety. It will be real cool if I do this and it turns out good and I can report back with the good news.

 

[Mailady]

Thinking of you Sub2974. Let us know how your visit goes. Thanks for your reply on my post.

 

[shub2974]

Thanks Mialady! My appointment isnt until next Friday so i have a whole week to sit and fret over it

 

[brit]

Mailady
Are you planning on telling the new dentist about the previous problem?...you don't have to mention names (it's best not to actually) -I think it would be better if you did tell the new dentist.
Get practising those relaxation exercises....relax, lie back, you're on a beach with a little help from nitrous maybe .
Good luck - actually you could always look on the bright side...it's not going to be any worse at the new place is it?

 

[Gordon]

1. Just wondering how significant is this anxiety effect.....are you only talking about fairly high levels of anxiety...where you feel 'physically scared'. If you are physically relaxed and not tense (I'm good at physically relaxing once in situ) does that preclude  anxiety preventing numbing from working?  

Since it appears to be a physical process, then I would guess that physical relaxation is the secret.

2. If you left and then got numb - that would be a sign that anxiety was the problem - true or false?

No, the theory is that the local has been washed away by the bloodstream, so nothing left to get numb.

3. So what's the answer to this for patients who can't easily physically relax....is it really just nitrous (not that widely available in Europe) or is it improved chairside manner, hypnosis etc? Should people reschedule?

Chairside manner for sure, I got pretty good results with phobics without sedation or anything a few years ago. Took me a long time though!

4. Why does anxiety not seem to interfere with other forms of medical numbing? Is this a uniquely dental problem? Actually maybe I don't want to know the answer to that  .

Probably because the mouth has such a great blood supply, plus in other areas then you'd be looking at a direct nerve block, eg an epidural.

 

[Mailady]

Well, I finally got the courage mustered today to call the new dentist office. I set up a consultation for April 11. I wish I could get past the fear that I will take pills, they will think I'm sedated, and will drill away while I feel it, but am unable to tell them. Gordon, what exactly does sedation do/block, etc.? They said they usually block out a day when they do everything ( all work that needs to be done in the mouth)if they do the sedation dentistry. I think she said $350.00 for the whole day. A lot better than the $3800 plus at the other place. This place uses pills, though, the other place IV. These people are supposed to be really well trained and up on things though. My preference would probably be to be coherent and just be able to get numb, and be able to walk out afterwards and drive, etc. If I knew I would get the pills AND be numbed, and knew I wouldn't feel it, I might go for getting the works done in one day though.

 

[Gordon]

Sedation doesn't turn you into a zombie, you're perfectly able to communicate pain or discomfort. You might not CARE about them for long, but you'd feel it and be able to say so.

Is this the DOCS protocol they'll be using?

 

[Mailady]

Thanks for the info Gordon. I don't quite understand your question about DOCS. Do you mean the doctor? Or does DOCS stand for something?(Abbreviation?).

 

[Gordon]

It's a specific oral sedation protocol. If your practice has signed up to it then they'll probably mention it someplace.